Trial Information

A Multi-Site Replication of an Inpatient Palliative Care Program

The Inpatient Palliative Care Service (IPCS) was implemented at three Kaiser-Permanente
sites: Colorado, Portland and San Francisco. The service consisted of a physician, nurse,
social worker, and spiritual counselor who worked with the study subjects randomized to
receive the intervention. The intervention included symptom control, emotional and spiritual
support, advance care and post-discharge care planning, There were no differences in symptom
control or emotional support but IPCS patient reported better spiritual support compared to
usual care patients. IPCS patients also reported greater satisfaction with their hospital
care experience and better communication with their providers. Both IPCS and usual care
patients reported improved quality of life during their enrollment hospital stay. IPCS
patients completed more advance directives. IPCS patients had more home health visits than
usual care patients but significantly fewer ICU admissions. IPCS patients had significantly
lower hospital costs and higher pharmacy costs, than the usual care patients. IPCS patients
had significantly lower (p= .001) total health services costs (a cost savings of $64.90 per
patient per day) compared to usual care patients. This translated to an average total cost
savings of $3,185 per enrolled patient. IPCS patients had a significantly longer average
hospice length of stay. There were no differences between IPC and usual care patients in the
proportion admitted to hospice, time to hospice admission, the average length of survival,
or proportion of those who survived to 6 months.

Conclusion: IPCS resulted in better spiritual support, a better hospital care experience,
better communication with their providers, increased completion of advance directives, fewer
ICU admissions, longer hospice stays and reduced overall health care costs.